April14 issue by The Sober World,LLC

WHY YOUR DOCTOR MAY NOT BE THE BEST CHOICE TO TREAT ADDICTION BREAKING THE CODEPENDENCY HABIT THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS AFTERCARE PROGRAM A MUST FOLLOWING ALCOHOL OR DRUG REHAB “WE’RE AT WAR”: BATTLING THE “LEGAL HIGH” DESIGNER DRUGS AND EMERGING NATURAL SUBSTANCES THE MANY FACES OF EARLY SOBRIETY

EVIDENCE BASED TREATMENTS FOR ADOLESCENT SUBSTANCE USE AND DSM-5 MENTAL DISORDERS FAMILIES ANONYMOUS (FA) PROVIDES HOPE FOR FAMILIES AND PARENTS OF ADDICTS OVERCOMING ROADBLOCKS TO RECOVERY: THE EMERGING BRAIN SCIENCE OF ADDICTION, TRAUMA AND SHAME WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? MEDICAL MARIJUANA: 5 MEDICAL MYTHS DEBUNKED OUT OF THE WOODS LET’S EXPLORE THE LEARNED COMPONENT OF MOTIVATION

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A LETTER FROM THE PUBLISHER Dear Readers, I welcome you to The Sober World magazine. This magazine is being directly mailed each month to anyone that has been arrested due to drugs and alcohol in Palm Beach County. It is also distributed locally to all Palm Beach County High School Guidance Counselors, Middle School Coordinators, Palm Beach County Drug Court, Broward County School Substance Abuse Expulsion Program, Broward County Court Unified Family Division, Local Colleges and other various locations. We also directly mail to many rehabs throughout the state and country. We are expanding our mission to assist families worldwide in their search for information about Drug and Alcohol Abuse. Our monthly magazine is available for free on our website at www.thesoberworld.com. If you would like to receive an E-version monthly of the magazine, please send your e-mail address to patricia@thesoberworld.com Drug addiction has reached epidemic proportions throughout the country and is steadily increasing. It is being described as “the biggest man-made epidemic” in the United States. More people are dying from drug overdoses than from any other cause of injury death, including traffic accidents, falls or guns. Many Petty thefts are drug related, as the addicts need for drugs causes them to take desperate measures in order to have the ability to buy their drugs. The availability of prescription narcotics is overwhelming; as parents our hands are tied. Doctors continue writing prescriptions for drugs such as Oxycontin, and Oxycodone (which is an opiate drug and just as addictive as heroin) to young adults in their 20’s and 30’s right up to the elderly in their 70”s, thus, creating a generation of addicts. Did you know that Purdue Pharma, the company that manufactures Oxycontin generated $3.1 BILLION in revenue in 2010? Scary isn’t it? Addiction is a disease but there is a terrible stigma attached to it. As family members affected by this disease, we are often too ashamed to speak to anyone about our loved ones addiction, feeling that we will be judged. We try to pass it off as a passing phase in their lives, and some people hide their head in the sand until it becomes very apparent such as through an arrest, getting thrown out of school or even worse an overdose, that we realize the true extent of their addiction.

provide medical supervision to help them through the withdrawal process, There are Transport Services that will scoop up your resistant loved one (under 18 yrs. old) and bring them to the facility you have chosen. There are long term Residential Programs (sometimes a year and longer) as well as short term programs (30-90 days), there are Therapeutic Boarding Schools, Wilderness programs, Extended Living and there are Sober Living Housing where they can work, go to meetings and be accountable for staying clean. Many times a Criminal Attorney will try to work out a deal with the court to allow your child or loved one to seek treatment as an alternative to jail. I know how overwhelming this period can be for you and I urge every parent or relative of an addict to get some help for yourself. There are many groups that can help you. There is Al-Anon, Alateen (for teenagers), Families Anonymous, Nar-Anon and more. This is a disease that affects the whole family, not just the parents. These groups allow you to share your thoughts and feelings. As anonymous groups, your anonymity is protected. Anything said within those walls are not shared with anyone outside the room. You share only your first name, not your last name. This is a wonderful way for you to be able to openly convey what has been happening in your life as well as hearing other people share their stories. You will find that the faces are different but the stories are all too similar. You will also be quite surprised to see how many families are affected by drug and alcohol addiction. Addiction knows no race or religion; it affects the wealthy as well as the poor, the highly educated, old, young-IT MAKES NO DIFFERENCE. This magazine is dedicated to my son Steven who graduated with top honors from University of Central Florida. He graduated with a degree in Psychology, and was going for his Masters in Applied Behavioral Therapy. He was a highly intelligent, sensitive young man who helped many people get their lives on the right course. He could have accomplished whatever he set his mind out to do. Unfortunately, after graduating from college he tried a drug that was offered to him not realizing how addictive it was and the power it would have over him. My son was 7 months clean when he relapsed and died of a drug overdose. I hope this magazine helps you find the right treatment for your loved one. They have a disease and like all diseases, you try to find the best care suited for their needs. They need help.

I know that many of you who are reading this now are frantic that their loved one has been arrested. No parent ever wants to see his or her child arrested or put in jail, but this may be your opportunity to save your child or loved one’s life. They are more apt to listen to you now than they were before, when whatever you said may have fallen on deaf ears. This is the point where you know your loved one needs help, but you don’t know where to begin.

Deaths from prescription drug overdose have been called the “silent epidemic” for years. There is approximately one American dying every 17 minutes from an accidental prescription drug overdose. Please don’t allow your loved one to become a statistic. I hope you have found this magazine helpful. You may also visit us on the web at www.thesoberworld.com.

I have compiled this informative magazine to try to take that fear and anxiety away from you and let you know there are many options to choose from.

I want to wish all my readers a Happy Easter and Happy Passover.

There are Psychologists and Psychiatrists that specialize in treating people with addictions. There are Education Consultants that will work with you to figure out what your loved ones needs are and come up with the best plan for them. There are Interventionists who will hold an intervention and try to convince your loved one that they need help. There are detox centers that

To Advertise, Call 561-910-1943

We are also on Face Book at The Sober World and Steven Sober-World. Sincerely,

Patricia

Publisher Patricia@TheSoberWorld.com

IMPORTANT HELPLINE NUMBERS 211 PALM BEACH/TREASURE COAST 211 WWW.211PALMBEACH.ORG FOR THE TREASURE COAST WWW.211TREASURECOAST.ORG FOR TEENAGERS WWW.TEEN211PBTC.ORG AAHOTLINE-NORTH PALM BEACH 561-655-5700 WWW.AA-PALMBEACHCOUNTY.ORG AA HOTLINE- SOUTH COUNTY 561-276-4581 WWW.AAINPALMBEACH.ORG FLORIDA ABUSE HOTLINE 1-800-962-2873 WWW.DCF.STATE.FL.US/PROGRAMS/ABUSE/ AL-ANON- PALM BEACH COUNTY 561-278-3481 WWW.SOUTHFLORIDAALANON.ORG AL-ANON- NORTH PALM BEACH 561-882-0308 WWW.PALMBEACHAFG.ORG FAMILIES ANONYMOUS 847-294-5877 (USA) 800-736-9805 (LOCAL) 561-236-8183 CENTER FOR GROUP COUNSELING 561-483-5300 WWW.GROUPCOUNSELING.ORG CO-DEPENDENTS ANONYMOUS 561-364-5205 WWW.PBCODA.COM COCAINE ANONYMOUS 954-779-7272 WWW.FLA-CA.ORG COUNCIL ON COMPULSIVE GAMBLING 800-426-7711 WWW.GAMBLINGHELP.ORG CRIMESTOPPERS 800-458-TIPS (8477) WWW.CRIMESTOPPERSPBC.COM CRIME LINE 800-423-TIPS (8477) WWW.CRIMELINE.ORG DEPRESSION AND MANIC DEPRESSION 954-746-2055 WWW.MHABROWARD FLORIDA DOMESTIC VIOLENCE HOTLINE 800-500-1119 WWW.FCADV.ORG FLORIDA HIV/AIDS HOTLINE 800-FLA-AIDS (352-2437) 800-510-5553 FLORIDA INJURY HELPLINE GAMBLERS ANONYMOUS 800-891-1740 WWW.GA-SFL.ORG and WWW.GA-SFL.COM HEPATITUS B HOTLINE 800-891-0707 561-684-1991 JEWISH FAMILY AND CHILD SERVICES WWW.JFCSONLINE.COM LAWYER ASSISTANCE 800-282-8981 MARIJUANA ANONYMOUS 800-766-6779 WWW.MARIJUANA-ANONYMOUS.ORG NARC ANON FLORIDA REGION 888-947-8885 WWW.NARANONFL.ORG NARCOTICS ANONYMOUS-PALM BEACH 561-848-6262 WWW.PALMCOASTNA.ORG NATIONAL RUNAWAY SWITCHBOARD 800-RUNAWAY (786-2929) WWW.1800RUNAWAY.ORG NATIONAL SUICIDE HOTLINE 1-800-SUICIDE (784-2433) WWW.SUICIDOLOGY.ORG ONLINE MEETING FOR MARIJUANA WWW.MA-ONLINE.ORG OVEREATERS ANONYMOUS- BROWARD COUNTY WWW.GOLDCOAST.OAGROUPS.ORG OVEREATERS ANONYMOUS- PALM BEACH COUNTY WWW.OAPALMBEACHFL.ORG RUTH RALES JEWISH FAMILY SERVICES 561-852-3333 WWW.RUTHRALESJFS.ORG WOMEN IN DISTRESS 954-761-1133 PALM BEACH COUNTY MEETING HALLS

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WHY YOUR DOCTOR MAY NOT BE THE BEST CHOICE TO TREAT ADDICTION By Dr. Michael J. De Vito May 13, 2013, PBS News Hour reporter Jason Kane cites a Center for Disease Control study. The CDC states that 1 in 20 Americans have used prescription painkillers for non-medical reasons in the past year and many of them will become or are already addicted. That means 16 million Americans are active opiate addicts or are at risk for opiate painkiller addiction. The CDC study goes on to say that in 2010, over 16,650 people died of prescription pain medication. Four times greater than just 10 years earlier. A total of 125,000 deaths in the last 10 years have occurred due to the use of prescription pain medication. We now have the latest painkiller Zohydro, recently approved by the FDA. Zohydro is 10 times stronger than previous pain killing medications The number of active alcoholics or binge abusers is difficult to calculate but the number of alcohol induced deaths runs about 25,000 per year. That number is no doubt low when other alcohol related conditions leading to death are taken into account. Suffice it to say that the total number of alcoholics and alcohol abusers in our nation is high. Any number would be too many. Alcohol abuse is a frequent visitor to many families. Anti-depressant, anti-insomnia and anti-anxiety prescriptions have been on a meteoric rise over the last 10 years. The CDC says that anti-depressant medication is the most prescribed drug over the last decade. Between the years 1995 and 2002 the use of prescribed antidepressants increased 48%. Dr. Ronald Dworkin , a senior fellow at Washington’s Hudson Institute, says this “Doctors are now medicating unhappiness. Too many people are taking drugs when they should be making changes in their lives.” I totally agree with Dr. Dworkin. The number of people addicted to anti-depressant, anti-anxiety, anti-insomnia and other psychotropic medications that adversely affect healthy brain chemistry is on the rise and it is heart breaking. Approximately 40,000 people per year die needlessly due to the improper or proper use of anti-depressant medication. In addition to painkillers, alcohol, and the psychotropic medications listed above, we are a society abusing and addicted to marijuana, nicotine, methamphetamines cocaine, and many other substances and addictive behaviors. By all conservative accounts 30 to 50 million of us need help. Where do we go? For many the first call may be to our family physician. He is the person we have relied on and who has helped us with many health issues in the past. But is that the right choice now? I would strongly suggest no and here is why. The beginning of this article should tell you one thing. Doctors are diagnosis and prescription oriented. Their training and their world view purports that once maladies are diagnosed, treatment protocols, health restoration and health maintenance is primarily medication dependent. To some degree they have a logical historical basis for that view. Once we realized, a little over a hundred and fifty years ago, that doctors needed to wash their hands, before and after surgery or childbirth we made the connection between microbes and disease. Common sense practice and the eventual discovery of antibiotics and some vaccines have certainly saved lives. Before that time doctors were subject to ridicule or even put in the insane asylum if they suggested such a thing as clean water, physician hygiene or sterile operating room procedures. Research the lives of Dr. Joseph Lister or Dr. Ignaz Semmelweis. Afterwards say a prayer of thanks for the life of these two men. The advancements in treatment concepts often progress at a slow pace. In our time antibiotics that once saved lives are now over prescribed. Antibiotics are often used without regard for the benefit of their effect. As a result many of our life saving antibiotics have become ineffective. Pain medications are a benefit when used responsibly by physicians and patients. I would refer you to an article I wrote in The Sober World Magazine titled “Pain Medication and Addiction” November 2013. Needless to say, pain medications are not always prescribed or used responsibly. They are abused. What will most doctors do for a patient who makes an appointment for addiction treatment? Remember, through years of training they are pharmaceutically and prescription oriented. Many will follow the protocol of the Physician’s Desk Reference (PDR) or one of many pharmaceutical regimes discussed weekly over lunch with their regional pharmaceutical representative. For example,

Antabuse (disulfirum) may be prescribed for alcohol abuse. This drug interferes with the metabolic breakdown of alcohol causing sickness and discomfort whenever alcohol is consumed. In some cases hospitalization is needed to stabilize the user. Additionally, in some alcoholics Antabuse can also indirectly increase the mechanisms for the craving of alcohol and the acting out of other compulsive behaviors. Antabuse is meant as a deterrent and has been widely prescribed since the 1950’s. The benefit for anything other than short term sobriety in my opinion is questionable. Campral (acamprosate) is another medication that has become popular. It is supposed to balance and restore proper brain chemistry and help people stop the use of alcohol including some other addictive behaviors. They readily admit that the mechanism of how that happens is not well understood. In fact, Campral disrupts and distorts neurotransmitter balance. The side effects of Campral can be worse than the conditions it is meant to treat. There is also an effective natural substitute for Campral that is readily available without prescription. Would your doctor recommend that? For patients consulting physicians with dependencies to Heroin, opiate painkillers, anti-depressants and anti-anxiety or anti-insomnia medications, pharmaceuticals would once again be the most likely protocol. In the case of opiate dependency Suboxone or Methadone may be prescribed. These medications will stop withdrawal symptoms. Why would they not? Both are another form of opiate. The goal is to eventually wean the patient off of opiates. Research the success of those pharmaceutical therapies. How many Methadone maintenance clinics are now in the United States? In the case of anti-depressants or anti-anxiety medications the medical mindset is to try another form of the same drug and remain on that medication for life. If one SSRI (anti-depressant medication) is no longer having the desired affect try a different one, i.e. from Lexapro to Paxil or Zoloft. If one Benzodiazepine (anti-anxiety medication) has become a problem try another, i.e. from Ativan to Xanax or Klonopin. It all becomes a never ending cycle chasing sanity in the hope for better living through chemistry. Some more holistically aware physicians, like many Family Practitioners and Internists in my town, and hopefully yours, will refer those patients to a clinic with a more Holistic philosophy when it comes to addiction recovery. The good news is an increasing number of physicians are becoming more aware and informed of the benefits of treating addiction by way of a Holistic therapeutic approach. In the case of our program we limit pharmaceutical use to palliative or anti-seizure medications when they are needed. Medications will cease when the symptoms of withdrawal and any seizure risks have subsided. Usually within 5 to 7 days. Aftercare includes Holistic Drug Free protocols. For example, Auricular Therapy, Nutriceutical Supplementation, Counseling, The Master Keys to Recovery protocol, Chiropractic and other natural therapies that support a focus on sustained health and vitality. I take a firm Holistic approach to the treatment of addiction in the same way that I do to overall health and well-being. Switching one drug for another and calling it recovery makes no sense to me and it should not make sense to you. Dr. Michael J. De Vito is a diplomate and is board certified in Addictionology. He is a graduate of Mansfield University of Pennsylvania and Northwestern Health Science University in Minneapolis, Minnesota. He has been an instructor of Medical Ethics, Clinical Pathology, Anatomy and Physiology at the College of Southern Nevada. He is the founder and program director of NewStart Treatment Center located in Henderson, Nevada. NewStart Treatment Center utilizes a drug free and natural approach to addiction treatment. www.4anewstart.com Dr. De Vito is the author of Addiction: The Master Keys to Recovery www.AddictionRecoveryKeys.com

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BREAKING THE CODEPENDENCY HABIT Laurie Weiss, Ph.D.

Codependency is not a disease – it’s a habit! Codependency is a relationship based on a false premise or belief. The belief is that the needs and feelings of one person in a relationship are more important than the needs and feelings of the other person. When one member of the relationship is an addict his or her needs usually take precedent. The addict is also a codependent and participates fully in the false belief system. The best way to escape from a codependent relationship is to start acting as if your needs and feelings are just as important as the needs and feelings of your partner. In this case your partner can be your spouse, any member of your family, a friend, a coworker or anyone who shares this belief system with you. Of course, if you’re in a codependent relationship you both may have long forgotten, if you ever even knew, how to recognize your own needs and feelings. When you can’t recognize a problem you can’t do anything to solve it. Unmet needs hurt. You each solve the problem of managing that pain in different ways.

Change the Stories You Tell Yourself You learn to tell stories to explain a complicated world to yourself. Everyone does this. The problem is not that you tell yourself stories; the problem is that you believe them. Once you settle on a particular story or explanation of how things happen you forget that other explanations are possible. The story you tell yourself about who you are in the world has an enormous influence on how you approach problems. There are lots of different popular story themes that lead to different actions. An addict or an addict’s partner (both codependents) often tells stories about being powerless. • “I never do anything right.” You notice all your mistakes, criticize yourself for having the problem, wait around hoping someone else will fix the problem, and put off any action. You may do something to help you forget the problem like take a nap, surf the web or read your junk mail. If you’re an addict, you may use your substance of choice to manage your discomfort.

• If you’re the addict’s partner you use the addict’s problem behavior to distract you from what you need and feel.

• “It’s not my fault.” You notice everything that others do wrong and spend a lot of time and energy telling them about it. You’re angry that they don’t take your advice, and complain to your friends about how inconsiderate, incompetent and incapable other people are.

Even if you come to believe that your needs and feelings (yourself) are just as important, not more important, and not less important, then the needs of your partner (himself or herself), it still will take work to change the codependent pattern. And even if you don’t believe that you and your partner are equally important. You can change the pattern by changing your behavior, one step at a time. Once you do that, your beliefs will probably change also.

• “If I want something done right, I have to do it myself.” When you’re in relation with an addict, you stay on top of all the details and make sure everything is done correctly. You are super responsible, overcommitted and exhausted. The stories you tell yourself are like old habits. They are familiar and comfortable. If you change your story, you will start to notice different things about the world, and these will lead you to take different actions. There are a couple of alternative themes that you might consider adopting.

You can learn to do each of these three important things a little bit at a time in no particular order.

• “I’m a competent person.” You notice the resources you have available – money, friends, time, transportation, etc., and start using them to find a solution to whatever challenge you are facing.

• If you are an addict, you “use” something to distract yourself from the pain.

1. Identify your emotions and use them as signals to help you discover what you need. 2. Change the stories you tell yourself about who you are. 3. Practice making healthy decisions that take into account your needs and feelings, your partner’s needs and feelings, and the realistic limitations of every situation you’re in. Identify Your Emotions The best way to learn the language of your emotions is to tune into the sensations in your body: • Anger – Some people experience anger with tightening of muscles, and impulse to strike out, and sometimes a feeling of heat. To learn your own signals, notice how you feel when you are frustrated in getting something you really want. • Sadness – This is often experienced by lack of energy, a feeling of collapse, a tightening in the throat or an urge to cry. • Fear – some people report fear as an inability to move. Some experience a coldness or “shaking like a leaf.” Others experience it as butterflies in the tummy or even severe abdominal distress. Some feel the physical impulse to run and hide. • Joy – this is often experienced as a lightness, and excitement. Accompanied by an urge to move. Sometimes a release of tension leads to tears of joy. Sometimes you get your signals crossed. You may feel an urge to cry when you’re angry, as well as when you’re sad. You might feel an urge to strike out when you’re frightened. It is important that you learn to calibrate your own impulses instead of acting on them immediately. Once you’ve learned to do this, you can use your feelings as information that you need or want something. Then you can stop and think about what would actually relieve your discomfort – or allow you to express your joy. You’ll learn that emotions are temporary. Often they dissipate soon after you express them. Their purpose is to signal you that you need something so that you take action to take care of yourself. As you learn to think about your feelings and take action to get what you need, you won’t need to distract yourself by using substances or concern for others to ease your pain.

• “I live in a wonderfully exciting world.” You see problems as challenging opportunities. You explore creative solutions and if they do not work out, you try new ones. If you are living a story you do not like, choose a new one to try on and play with it. It’s a little like buying new clothes. Spend a few minutes every day, reminding yourself about your new story. Paste your new story on your bathroom mirror, your refrigerator, your desk or the steering wheel of your car. The more you practice, the easier it will be to stop feeling like a victim of your old story. Practice Making Healthy Decisions. If you’re in a codependent relationship you typically make decisions that count only your own needs and feelings, or the needs and feelings of your partner in the relationship. A very simple way to get out of the codependence habit is to practice making decisions that take into account both your own and your partner’s needs and feelings. This means thinking and talking about what each of you wants, and learning to negotiate. It also means approaching the world realistically and accepting your social and financial limits so that the decisions you make together support your growth. Breaking the codependent habit is a challenge and it’s definitely a challenge worth accepting! Laurie Weiss, Ph.D. has been helping heal codependent relationships for over 40 years. She is an internationally known psychotherapist, coach and author of 6 books and dozens of articles. Her print and Kindle books are available at www.amazon.com/author/laurieweiss . Download your Kindle edition of Emotional Self Help: I Don’t Need Therapy,.. But Where Do I Turn for Answers? for additional resources for breaking the habit of codependency. Dr. Laurie Weiss has been in private practice with her husband since 1972. John Bradshaw says “The Weisses are the best...therapists who use a true developmental approach. I am indebted to them.” www.EmpowermentSystems.com, www.LaurieWeiss.com laurieweiss@empowermentsystems.com

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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS

OVER 100,000 PEOPLE HAVE PERISHED ALREADY – SOME OF THEM IN MY ARMS By John Giordano DHL, MAC

Albert will never know what it’s like to cheer on his college football team or date the co-ed of his dreams. The tall and handsome blonde haired, blue eyed high school junior, who grew up in an upper-middle class family, was a bright student with a promising future. At 17 years old, Albert was dead – he took two pills, Methadone and Xanax, and those shut down his breathing. My heart goes out to Albert’s parents. I know how they feel as I nearly lost my son to an overdose.

field on the verge of an explosion,’’ Carr says. ‘’There’s no area of medicine with more growth and more public interest. Others called it a watershed moment. Mark Sullivan, MD, a professor of psychiatry and behavioral sciences at the University of Washington calls it “a situation that was ripe for the influence of the pharmaceutical industry.” “Doctors are prescribing like crazy,” said Dr. C. Richard Chapman, the director of the Pain Research Center at the University of Utah.

Albert’s short life ended by a prescription drug overdose is emblematic of our current opium epidemic. It is beyond reason and sane thought that everyone in the pharmaceutical and medical fields are walking around aimlessly pretending there is not a problem and hiding from the fact that eight out of every ten opioid painkillers produced in the world is consumed by Americans. That translates into less than five percent of the global population consumes eighty percent of the world’s production of prescription painkillers. By any standards, this is a severe epidemic that is not caused by a virus or bacteria. Yet at a time when FDA approved prescription painkillers are involved in nearly 60 percent of all drug overdoses and three out of four overdose deaths, the most potent opioid painkiller ever imagined has been approved by the Food and Drug Administration – the government agency tasked with protecting the public’s health. This is complete and utter insanity! Alert the morgues because people are going to start dying within days of this poison hitting the market.

By 2010, pharmaceutical companies were selling four times as many prescription painkillers to pharmacies, doctors’ offices and hospitals as it did 10 years earlier. Research indicates that while opioid prescriptions increased throughout the 2000s, so did the dose of each pill. CDC researchers found that the average size of an oxycodone prescription - the entire amount in the bottle - increased from the equivalent of 923 milligrams of morphine in 2000 to 1,566 milligrams of morphine in 2010. Hydrocodone, the opioid used in Vicodin, the average dose per prescription increased from the equivalent of 170 milligrams of morphine in 2000 to 288 milligrams in 2010. Distribution of morphine, the main ingredient in popular painkillers, increased 600% from 1997-2007, according to the U.S. Drug Enforcement Administration. 241 million prescriptions for opioid painkillers were written in 2012 alone. Today, the ‘Chronic Pain’ market is estimated to be in the $22 billion dollar range.

Zohydro is due to rollout this month (March 2014). It’s a hydrocodonebased drug that is banned in most modern countries. It joins a long line of (opioid analgesics) painkillers already available on the glutted U.S. market. What differentiates Zohydro from its competitors (Lorcet, Lortab, Norco, Vicodin, Vicodin ES, Vicodin HP, Anexsia, Lorcet Plus, Zydone, etc.) is that it is estimated to be about five times more potent than anything on the market today and comes in an easy to crush coating – a trait synonymous with potential for drug abuse. Addicts will crush pills and then swallow, inject or snort the powder like substance. However, what truly makes Zohydro unique is that it is pure hydrocodone. Its competitors add an additional drug like acetaminophen to improve the efficacy and also as an abuse deterrent. The FDA said it approved the extended-release pill Zohydro ER for patients with pain that requires “daily, around-the-clock, long-term treatment” that cannot be treated with other drugs. As I stand here before you, I swear that in nearly thirty-years of addiction treatment, having worked with world leading experts on the subject, I’ve never heard of anyone in such pain that available pain medication couldn’t handle. Just how did we get here? It wasn’t that long ago that opioid painkillers were once reserved for terminal cancer patients. The FDA was started in response to companies more concerned with their bottom line than that of their customers. It was formed in 1906 with the Pure Food and Drugs Act, signed into law by then President Theodore Roosevelt to protect Americans from companies marketing dangerous and/or deadly products. So what changed? An article published in the Journal of the American Medical Association (JAMA) opened the floodgates to our current opium epidemic. In 1997, 2 expert panels in the United States introduced clinical guidelines for management of chronic pain. Both guidelines encouraged expanded use of opioid pain medications after careful patient evaluation and counseling when other treatments are inadequate. They also claimed the risk of addiction was low. Two groups represented on the expert panel, American Academy of Pain Medicine and American Pain Society, have taken millions from the very same pharmaceutical companies who stood to benefit the most from the adoption of a broader policy towards prescribing opioid painkillers. Was this financial arrangement a quid pro quo for a favorable report to JAMA – the bible of the medical profession? This is an all too familiar playbook. In 2001 the New England Medical Center medical director, Dr. Daniel Carr, told the New York Times’ Melanie Thernstrom this, ‘’It’s a

In the early part of the twentieth century streptococcal infections were treated with the drug Sulfanilamide which came in a pill and powder form. To meet the growing interest of Sulfanilamide in liquid form a pharmaceutical company in Tennessee tasked its chief chemist and pharmacist to develop the Elixir. The S.E. Massengill Co. chief chemist, Harold Cole Watkins, found that sulfanilamide would dissolve in diethylene glycol (a.k.a. anti-freeze). The company tested their new product for taste, fragrance and appearance and found it to be completely satisfactory. At this time in our history, it was not required of a pharmaceutical company to test its products for toxicity before they hit the market. In the late summer of 1937, Massengill shipped their Raspberry flavored elixir all over the country. Soon after, the country became outraged. People across this great land of ours were dying from a medicine made right here in the U.S. and prescribed by their trusted physicians. The anguish was unbearable. Americans felt betrayed and became skeptical. Congress knew the Food and Drugs Act of 1906 was weakened. They debated on how to shore it up for years prior. It took the deaths of over one-hundred Americans before Congress finally passed the 1938 Food, Drug, and Cosmetic Act, which put teeth into the FDA by giving it authority to regulate drugs. Fast forward to 1999 – over four-thousand Americans died that year from prescription drug overdoses. The public is infuriated. They begin forming groups to bring greater awareness of the problem in an effort to effect change. But all of their continued efforts are for not. Prescription drug overdoses persist. Once again, fast forward another fifteen-years to March 2014. More than an estimated seventeen-thousand Americans will die from prescription drug overdoses this year – one every 19 minutes. The Center for Disease Control (CDC) called prescription drug addiction an epidemic long ago. The FDA and Congress have the power to stop these preventable deaths, but instead they chose to fuel this crisis with their silence. This year enough prescription painkillers will be prescribed to keep every single American adult sedated 24/7 for an entire month! Yet complete silence from the very people charged with keeping us safe. Recently I read a headline regarding three hundred and three people dying over a ten year period as a result of faulty air bags in cars. Threehundred people die from prescription drug overdoses every week. However, it was the air bags that caused indignation in the voices of lawmakers. How could a car manufacturer be so irresponsible as

Continued on page 30

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MEDICAL MARIJUANA: 5 MEDICAL MYTHS DEBUNKED An Article Provided by Suncoast Rehab Center

The heated medical marijuana debate still rages through Florida – and it will likely continue until the last voting day in November. Advertisements state the mythical “benefits” of marijuana. These myths are busted here: Myth #1: I tried marijuana in my youth and it wasn’t that bad. Fact: THC is the chemical in marijuana that gets you high. Twenty years ago, the THC levels were much lower than they are today. That is because the marijuana found in present day has been selectively bred in such a way as to increase THC levels. Current strains of marijuana is consistently bred so as to create a plant that gives a much stronger high than that experienced by anyone even 10 years ago. Myth #2: Medical marijuana will bring more tax money into the community. Fact: For every dollar we get in taxes on addictive substances, we spend $10 in social costs. Enforcement agencies and committees to enforce legalized substances are created. We need committees to study its effects. Florida will have to form new regulatory agencies to review and oversee policies. Myth #3: Marijuana isn’t addictive. Fact: Not only is marijuana addictive, it is a gateway drug. In a survey done of 100 addicts, just over 90% of them have marijuana listed right at the top of their drug list. Often, their drug habit started at marijuana, then escalated to another addictive substance like cocaine, methamphetamine, or prescription drugs.

Myth #4: Marijuana isn’t harmful. Fact: Marijuana abuse can lead to changes in behavior, poor cognitive thinking, and reduced short-term memory, altered perception of reality, lethargy, and lack of motivation, paranoia, decreased IQ, and anxiety. When used on a long-term basis, users experience a reduced ability to learn and retain new information and permanent mood or personality changes. Studies have shown a link between marijuana abuse and schizophrenia. Additionally, when adults do drugs, young people inevitably perceive the drug is “safe.” This means that if medical marijuana is used around young people, they will try it themselves. Young, developing brains are most susceptible to the injurious effects of medical marijuana. Regular abuse of marijuana in teenage years leads to a permanent decrease in IQ. Other research links this use to heightened risk of developing psychosis Myth #5: The current amendment proposed will only apply to people who are terminally ill. Fact: Under the current wording of the amendment that will go up for vote, use of medical marijuana will be allowed “for individuals with debilitating diseases as determined by a licensed Florida physician.” This means that any person with a disease can visit a Florida physician and if the doctor decides the individuals’ disease is debilitating, he can be prescribed marijuana. If the recent fiasco of pill mills is any indication of what could occur with medical marijuana, do we really want to hand this decision over the Florida physicians? If you or someone you know is suffering from addiction, contact Suncoast Rehabilitation Center at (866) 572-1788. You can also review our website at www.SuncoastRehabCenter.us.

AFTERCARE PROGRAM A MUST FOLLOWING ALCOHOL OR DRUG REHAB By Marlene Passell

Completing drug or alcohol rehab is definitely a time to celebrate your accomplishments, but it doesn’t mean you don’t have more work to do. As several addicts in recovery have told me, during the weeks, months and even years after completing rehab, they still felt at risk for relapse. Having a co-occurring disorder — a mental health condition that occurs along with a substance use disorder — increases the risk of falling back into addictive behaviors and self-destructive patterns. Aftercare programs help minimize that risk, and keep you moving forward on the road to a completely drug-free life. The quality of the aftercare you receive can have a strong influence on your chances of remaining sober after you finish treatment, according to research conducted by Psychiatric Services. A plan for aftercare should be built into any comprehensive treatment program and your treatment team should help prepare you for the days following your graduation. With the right kind of assistance and therapeutic support, you can maintain your hard-won sobriety and build a solid foundation for recovery. Relapse Prevention Addiction specialists now recognize that relapse is a hallmark symptom of addiction. If you have a co-occurring disorder like depression, anxiety or post-traumatic stress disorder, the temptation to revert to substance abuse to manage your symptoms is even stronger. Through continuing counseling, group sessions and other scheduled meetings, aftercare programs provide an extra level of accountability that helps ensure that you don’t fall back into old habits. Alcohol Research & Health identifies the following components of an effective relapse prevention program: • Learning about your triggers. There are a lot of environmental, social and psychological factors that can trigger substance abuse.

An episode of depression, a flashback to an abusive situation, a conflict in your marriage or a stressful public event may drive you to turn back to drugs or alcohol. As part of relapse prevention, you should learn how to identify these stressors. • Coping with stressors and cravings. After graduating from rehab, you’ll be faced with a lot of situations that you may not have considered during treatment. Getting a new job, starting a new relationship or moving to a new home may leave you in an emotionally vulnerable state. Counseling sessions and support groups can help you cope with these high-risk situations. • Thinking through the outcome of a relapse. Many recovering addicts go back to drugs or alcohol with the expectations that these chemicals will make them feel better. In fact, drinking and drugging usually result in unpleasant or dangerous outcomes, such as an overdose, loss of a relationship or incarceration. A relapse prevention plan teaches participants to evaluate the potential outcome of a slip before taking that first drink or picking up drugs. • Keeping a lapse from turning into a relapse. A minor slip doesn’t have to turn into a major relapse if you seek help immediately and take steps to get back to your program. Because the chances of relapse are so high, it’s important to learn how to cope with the occasional slip if it does occur. Most rehab programs have aftercare services. For example, at Delray Beach’s Wayside House, women attend a 24-session Intensive Outpatient Program after completing the 90-day residential program. Marlene Passell is Communications Manager for Wayside House, an addiction treatment program by women, for women in Delray Beach. www.waysidehouse.net or call 561.278.5500.

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“WE’RE AT WAR”: BATTLING THE “LEGAL HIGH” DESIGNER DRUGS AND EMERGING NATURAL SUBSTANCES By Pat Pizzo, Director of Toxicology, Alere Toxicology Services

“Ladies and gentlemen, we’re at war,” Lance Dyer told an audience gathered for a community drug forum at Gwinnett Technical College in Lawrenceville, GA in December. “These are poisons,” he added, referring to synthetic marijuana. Dyer’s son Dakota, an otherwise successful and active teen, committed suicide after becoming a user of what was being promoted as a “new legal weed.” Dakota’s tragic story is not the only one. In the last few years the public has become increasingly interested in a number of synthetic substances that mimic the affects of illicit drugs. Found online and in stores (as well as exchanged among friends and associates), these psychoactive herbs and chemicals come in many forms including what are known as “cannabimimetics,” so-called “designer drugs,” and plant material. They are not marketed as a means to getting high and are often labeled as herbal incense, plant food, or bath salts. Unfortunately, these substances are easily obtained, often smoked or ingested by people who think they are legal and safe, and carry with them serious and sometimes deadly consequences.

Synthetic Cannabinoids What exactly are synthetic cannabinoids? They are a class of substances that are structurally diverse that bind to the cannabinoids receptors (CB1 and CB2) and produce similar psychoactive effects as cannabis. The synthetic cannabinoids actually show a greater affinity to the cannabinoids receptors than THC. This means the synthetic cannabinoids are often many times more potent than marijuana. HU-210, for example, is a synthetic marijuana compound thought to be 100-800 times more potent than THC. The first synthetic cannabinoids compounds were identified in the United States in 2008. The Poison Control Center has been an excellent source to track the usage of the synthetic cannabinoids in the United States. Their data first showed a dynamic increase than a gradual decrease in synthetic marijuana use. Table 1 Table 1

Cities, counties, states, and even the U.S. Drug Enforcement Agency (DEA) have enacted laws to prevent the retail sale and use of these products; however, the success of such laws as a deterrent is questionable. Many items containing synthetic marijuana and other mind-altering substances are still available online, and new compounds are regularly developed and marketed in innocuous ways. The chemical structure of the molecules within these items can easily be altered to create different compounds with the same effects on humans. The term and concept of “research chemicals” was coined by some marketers of designer drugs. The idea was that the intent clause of the U.S. analogue drug laws could be avoided by selling the chemicals for “scientific research” rather than human consumption. People are still obtaining and using these highly dangerous products, and law and drug testing must hustle to keep up. Cannabimimetics Cannabimimetics, often called Synthetic Cannabinoids or Synthetic Marijuana, are not new and are known to have the same affects on the brain as the active ingredient of marijuana – tetrahydrocannabinol or THC. Synthetic marijuana is most commonly marketed under brand names such as K2, Spice, MoJo, Black Mombo, Dragon Spice, and Yucatan Fire and in many other herbal incense blends where plant or herbal mixtures are sprayed with psychoactive chemicals. The plants and herbs include Blue or Pink Lotus water lilies, Lion’s Tail, Dwarf Skullcap, Indian Warrior, Siberian Motherwort, and Maconha Brava, which is also called “false marijuana.” Alone they have an effect on humans ranging from euphoria and relaxation to sexual stimulation, but when treated with synthetic cannabinoids they can create more intense or longer lasting highs. Often more than one synthetic cannabinoid is added to the product. Available on the Internet as well as at head shops and gas stations, cannabimimetic products are sold as incense and labeled as “not for human consumption,” but people smoke and ingest them as a substitute for marijuana. The active chemical compound in many of these products, JWH-018, was first synthesized in 1995 by John W. Huffman. It is only one of more than 470 synthetic cannabinoids and metabolites that have been prepared by Huffman and other scientists. Huffman is often quoted acknowledging the danger of smoking a product not intended for humans as a foolish action that could lead to death. “‘It’s like playing Russian roulette,” he is fond of saying in multiple sources. “You don’t know what it’s going to do to you.” July 2012, President Obama signs Synthetic Drug Abuse Prevention Act, instituting a federal ban on 31 designer drugs. The original ban identified 15 synthetic marijuana drugs and 5 drug classes as Schedule 1 drugs. In May 2013, 3 new synthetic marijuana compounds were added to the emergency schedule 1 (temporary) ban by the DEA.

As the chart shows, calls to poison centers have decreased. There are at least two possible explanations for this trend: first, decreases in overall usage related to heightened media exposure about the negative effects of these drugs combined with recent federal and state bans on the substances; and second, ‘chemists’ may have figured out relatively safer drugs to manufacture. Yet, a 2013 survey by the Center for Substance Abuse indicated that synthetic marijuana was the third most reported substance used by U.S. high school students in 2008—1-in-9 high school students admitted to using K2. Some users reported using synthetic marijuana to avoid a positive drug test and then admitted they returned to real marijuana use when not being subject to testing. If we look at the choice of synthetic marijuana compounds used over the last three years it reveals a change in the popularity of certain compounds. In 2010, prior to the initial temporary ban of five compounds, the most popular brand was K2, which would typically contain any number of JWH compounds such as JWH018, JWH073 and JWH250. Very few brands of synthetic cannabinoids were available. In 2011, after the temporary ban was put in place, the selection of brands went from a few to a few hundred and the ingredients changed to compounds such as JWH081, JWH201, RCS4 and AM2201. In July 2012, the Synthetic Drug Abuse Prevention Act was signed identifying 15 synthetic marijuana compounds and 5 synthetic marijuana drug classes as Schedule 1 controlled substances. This created a 3rd generation of synthetic marijuana compounds and late 2012 brought the emergence of XLR-11, UR-144, AKB-48 and JWH122. As 2013 dawned the 4th generation of synthetic marijuana compounds emerged with active ingredients such as PB-22, BB-22 and 5F-PB-22. In May of 2013, the DEA passed a temporary ban on three additional synthetic marijuana compounds: UR-144, XLR11 and AKB48, all 3rd generation compounds popular in 2012. Continued on page 26

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THE MANY FACES OF EARLY SOBRIETY By Marcia Ullett, MA

I’m not 100% sure I know what I expected from early sobriety, but I don’t think I imagined the complex picture that presented itself to me. I guess I expected life to clean itself up, just like that. I thought all my problems would magically disappear. Instead, my life was full of the unexpected. Some of it was wonderful, but so much of it was a tangled and confusing mass of emotions, a journey into the unknown that, without the aid of alcohol and drugs, terrified me. There were two fears that I remember distinctly when I first got sober. The first was that I would never “get it.” On the one hand I felt like everyone else in the meetings I went to was happy and knew each other whereas I, newcomer that I was, could barely talk to anyone. Add to that the fact that I was really angry—about everything. Was this what my life was always going to be like? My whole life I had struggled with the feeling that I didn’t belong anywhere. And here I was, in a room full of alcoholics like me, still feeling like I didn’t belong. On the other hand, I was suspicious that these people couldn’t possibly be that happy. They had to be lying or at the very least pretending. It was like they had all drank the same cool aid and had been brainwashed. I was scared and discouraged. My own life in recent years had been very dark, and it was impossible for me to accept that there was this much light anywhere on the planet. Despite these feelings, I was afraid to leave. I had tried and tried to get sober on my own, and it didn’t work. I was feeling desperate—afraid to live and afraid to die.

Part of the problem could be a condition known as Post Acute Withdrawal Syndrome or PAWS. PAWS can occur one to two weeks after stopping alcohol or drugs, once detoxification or acute withdrawal is over. It’s a collection of symptoms that result from some combination of damage to the nervous system caused by the use of alcohol and drugs and the stress of living without alcohol and drugs. The symptoms can include anxiety, emotional outbursts or lack of emotion, lack of energy, difficulty sleeping and coping with stress, memory problems, trouble making decisions or thinking clearly, and depression. Other symptoms can be an inability to concentrate for any period of time and problems with physical coordination. Any of these symptoms can make us feel scared and “not okay.” For these reasons, we need to know that this situation isn’t unusual. PAWS has been known to continue for weeks or months, sometimes up to a year or two in the case of longer and heavier use of alcohol or drugs. The best news about PAWS is that with healthy living and a solid program of recovery it gets better. However, it takes time and patience, but the symptoms will likely recede if we hang in. The facts are that we are not going crazy, nor are we inadequate or deficient. This stuff is what they call the wreckage or our past. When you think about it, it makes sense that patience is needed for us to heal, to learn to live in this new way. We need time for our brains to return to normal, to restore our bodies to health, and to develop new coping skills. After all, any problem prior to this time was usually met with alcohol and/or drugs.

One of my sober friends says this about his early sobriety, “I had lived a life where no one wanted me for me. They either wanted drugs or something else from me. I learned not to trust anyone. When people reached out to me in early sobriety I saw them as phony. I felt alone. I also experienced feelings of loss for the drugs as well as the lifestyle. I didn’t know how to act; my normal belligerence was gone and I was terrified in the world without it. None of this was obvious then, and I just floundered around, unsure of how to act--unsure and untrusting of everyone and everything around me.”

Obviously, the journey into sobriety is no cakewalk. However, the good news is that there are several solutions available that turn these difficulties into exciting discoveries about ourselves and about life in general. If we commit ourselves to these changes and stay the course, we get to be pleasantly surprised by what we find.

The second fear I remember was that I would never have fun again. It’s odd when I think of this today. At that time I was forgetting that the end of my drinking and using life was miserable. Everything I was doing at the time was a struggle. I was sure no one liked me, maybe because I didn’t like myself. I used to have to drink and/or use to “have fun.” But was it really fun? At the beginning it was definitely fun, but at the end, it was just crazy, and so was I.

Addiction is a disease of loneliness, and learning to be among other sober people, making friends, and sharing experiences is crucial to recovery. Many of us find laughter again in meetings.

I was resistant to any change, because I was scared of whom I would meet if I really got to know myself. I had escaped myself for many years. We do that. We live in a haze, hiding from life by anesthetizing ourselves through the use of substances. We forget who we were and what we really cared about. Stopping the alcohol and drugs makes us feel like we’re on some ledge, about to fall off. Another of my friends says this about her early sobriety: “I felt lonely, scared and trapped. I tried over and over to take back my admission that I was an alcoholic. It was important to me that I remain different from others; it was an identity thing. I thought they hadn’t had my experience. I refused to connect to the feelings of others and kept rejecting sobriety because the stories didn’t match. I thought I’d never be creative or have a great sense of humor again. When I was drinking I was popular and funny. When I got sober my friends at work no longer invited me to their parties because I wasn’t the fun drunk I used to be.” Looking back after all these years, I realize that my feelings, as well as those of my friends, were normal. Getting sober is a huge change. In the beginning, it was hard to believe that almost everyone in those rooms had experienced something similar to what I was going through. The feeling of vulnerability that almost all newcomers experience is frightening. We sometimes think something is wrong—that this isn’t the way it’s supposed to be. We imagine that everyone else is doing great and that we are unique in our uncertainty and anxiety.

Here are some tried and true solutions that will eventually change the pain of early sobriety into a rich and rewarding life. 1. Find 12-step meetings and attend them regularly.

2. Be willing to take direction from someone who has been there. Trust is difficult in early sobriety. Partly because of our own mistrust of ourselves and partly because of problems with others. Finding another sober human being who is willing to talk and listen to us is an important part of healing. This person can be a sponsor. 3. Work the 12-steps. The 12-steps outlined in the book Alcoholics Anonymous methodically take us down a path of learning the principles we need to recover and learn to live “life on life’s terms” so that we can fully embrace our new lives. 4. Be open-minded. Some of the suggestions we receive are new to us. If we are willing to change, we can find new ways of living and being in the world that may surprise us. Examples are prayer and meditation. At first, it may seem strange to do these things, but they are life changing and are worth a try. 5. H.A.L.T. This acronym is extremely helpful if taken seriously. It means: Don’t get too hungry, angry, lonely or tired. If you do, you risk relapse. Any of these conditions can set us up to feel like life sober isn’t any good, and we might as well pick-up a drink or drug. 6. Get phone numbers and call. Most people in meetings are anxious to talk to and help newcomers, especially ones who have the courage to call. Often we are wary to talk to others. For this reason, reaching out isn’t easy; however, it can help change lives. Continued on page 30

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EVIDENCE BASED TREATMENTS FOR ADOLESCENT SUBSTANCE USE AND DSM-5 MENTAL DISORDERS By Dr. Barry M. Gregory Ed.D., M.Ed., LMHC

Of the 1.6 million youths aged 12 to 17 who needed treatment for an alcohol or drug problem in 2012, only 10% received any treatment .The majority of adolescents received outpatient or intensive outpatient services. This gap in treatment services is due to cost and no insurance, a lack of teen treatment programs, a lack of referrals, parental ambivalence as well as teen resistance to treatment. The majority of teen referrals come from the criminal justice system where teens are mandated for treatment services. Some teen resistance is caused by normal development, by perceptions that they don’t have a problem and misperception that all teens drink or smoke pot. Teens frequently report parents don’t listen. While teens do use other illicit drugs, the majority is admitted to treatment or counseling for problems with high-risk use of alcohol and/or marijuana and co-occurring or separate emotional and behavioral problems. Adolescents frequently engage in a pattern of highrisk drinking where their sole purpose of drinking is to get drunk. This rapid style of drinking can result in alcohol poisoning, coma, death and/ or drunken driving fatalities. One night of high-risk alcohol or drug use by teens can result in tragedy for parents, families, and communities. In addition to high-risk alcohol and drug use, children and adolescents are referred to treatment for psychiatric disorders as well as social, emotional and behavioral problems. They are often referred for ADHD, depressive disorders, oppositional defiant disorder, conduct disorder, anxiety disorders, obsessive-compulsive disorder, childhood sexual abuse, PTSD and suicide. In 2011, an estimated 6.4 million children and adolescents aged 4 to 17 were reported to have a history of an ADHD diagnosis and 3.5 million of them were currently taking stimulant medications. While stimulant medications are commonly used and have been found to be effective for ADHD, behavioral interventions using contingency based home-school reward systems are available and effective in treating ADHD. In 1952, Riverside Hospital in New York City opened as the first adolescent treatment center for “juvenile addicts. For many years afterwards adolescent treatment was based upon adult treatment models and didn’t account for significant developmental or cultural differences. With advances in evidence-based practices today, there are a wide range of psychosocial treatments and therapies for children and adolescents. The most effective adolescent substance abuse treatments include Cognitive-Behavioral Therapy (CBT), Contingency Management (CM), Motivational Enhancement Therapy (MET), and Family-Based Treatments. Group treatment combined with both individual and family therapy sessions are most common at adolescent treatment centers along with psychiatric medications. A good course of action for parents and families concerned about a teen’s high-risk alcohol and drug use is to schedule a confidential screening and assessment appointment with a licensed professional trained in motivational assessment and treatment practices. Research has demonstrated that using a nonjudgmental and motivational style with adolescents during assessment and treatment significantly reduces resistance and improves retention and long term outcomes. The assessment helps to establish the severity of the problems and the level of motivation and readiness for treatment. Teens and parents then receive personalized written feedback about assessment results and work together with the clinician to determine the appropriate level of care. Adolescent treatment empowers parents and families to learn more effective ways to help their children struggling with addiction and emotional and behavioral problems. Sometimes a court order or an intervention is necessary to get adolescents into treatment where motivational and contingency-based interventions can help retain adolescents in treatment. In 1958 at Anna State Hospital in Illinois, Dr. Nathan Arzin, a student of B.F. Skinner, gave plastic tokens with the words “one gift” to female patients with schizophrenia who showed progress by starting to get dressed. These tokens were used by patients to purchase TV time, hair rollers and lipstick from the hospital store .Based on operant conditioning

and token economies from behavioral psychology, Contingency Management (CM) is a motivational incentive intervention designed to enhance initial motivation by rewarding and shaping healthy positive behaviors. Small rewards and privileges are provided to adolescents for complying with clearly defined treatment goals including: following group rules, completing chores, completing assignments, taking medications, or submitting clean urines. Many creative reward systems are used including prizes listed on slips of paper, points, vouchers, gift certificates and money that are used to purchase valued goods and privileges. Some adolescent treatment centers develop level systems that list program and behavioral expectations and privileges. Each week the treatment team and clients meet to determine if teens have completed assignments and engaged in positive behaviors and earned the right to move up to the next level. Peer feedback in these groups is very helpful and provides honest feedback to other peers about progress. With children and adolescent with ADHD, home chip systems are designed to increase desired behaviors like: (a) Getting dressed in the morning (b) Taking dirty dishes to the sink. (c) Making bed. (d) Not fighting with siblings. (e) Doing 15 minutes of homework. Kids earn chips to purchase rewards like watching TV, playing video games, having a friend over, going out for fast food or going bowling with the family. Frequently rewarded behaviors help to reduce inattention, impulsivity and hyperactivity with children who are diagnosed with ADHD. Despite many myths, stimulant medications have not been linked with increased risk for addiction. Most teens are referred to treatment or counseling for anger and aggressive behaviors. The new DSM-5 Disruptive, Impulse-Control and Conduct Disorders section includes Oppositional Defiant Disorder, Conduct Disorder and Intermittent Explosive Disorder. Research has established that angry and aggressive teens lack social problem solving, social perspective talking and emotional regulation skills. Angry and aggressive adolescents think other peers are out to get them and have learned early on that aggressive and violent behavior work. This distorted negative self-talk and lack of social problem solving skills leads to excessive angry emotional reactions and then aggressive and violent behavioral responses. Cognitive-behavioral therapy (CBT) teaches adolescents to improve their ability to understand what other peers are thinking and feeling, to change their self-talk, and skills to better regulate their emotions. It also teaches teens to generate options to typical adolescent interpersonal conflicts without resorting to aggressive behaviors. Gender separate treatment is sometimes needed because oppositional and defiant males in groups have a negative impact on other group members especially girls. Also key to successful treatment with angry and aggressive teens is parents learning positive parenting practices and skills. Recent research has found that family-based treatments are highly effective in treating adolescent substance use disorders. Teaching positive parenting practices and addressing parent stress and psychopathology are also key to better outcomes. In a recent large scale study, family therapy treatments including Functional Family Therapy (FFT) were compared to group CBT, individual CBT and a minimal treatment condition. FFT was found to be more effective than the 3 other treatments. FFT posits that adolescent substance use behaviors are developed and maintained by maladaptive family relationships. Treatment involves changing family interactions and improving family functioning. In Phase 1, motivational strategies are used to engage the client and family and to assess the quality of family relationships. Therapists help families better understand the meaning of everyday family dynamics. For example, parents may continue to allow a young adult son or Continued on page 28

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FAMILIES ANONYMOUS (FA) PROVIDES HOPE FOR FAMILIES AND PARENTS OF ADDICTS By Hanna McGoey, LMHC, CAP

I was recently invited to speak at a FA meeting. As a Certified Addiction Professional, I work with both the family members of addicts as well as the addicts themselves. I felt a bit overwhelmed as it had been a while since I spoke to a larger group of people but I remembered my usual tactic of reminding myself that the group in front of me had invited me and wanted to hear what I had to say. It helped that I could see much love and compassion but also sorrow and pain in the faces of the family members. I lectured for a few minutes on the topics that had been requested: Detachment and Boundaries and how family members must learn not to “enable the addict”. Detachment: Family members of an addict usually need to understand that in order to truly help the addicted person, the family member (mother, father, wife, husband etc.) must practice distancing themselves emotionally from the fact that the addict is in essence slowly destroying themselves. This is very difficult to do as this feels to the family members as if he or she is being told to “not care”. Boundaries: Most people need to learn how to set healthy boundaries and need to understand what boundaries are in the first place. But family members of addicts must practice setting emotional boundaries with the active addict more so than what might be considered normal. This is because the very nature of the substance abusers’ behavior is to do whatever it takes to continue using. The addict will cross any boundaries set by the family member, on a regular basis, on purpose, in order to ensure and maintain the continued flow of resources and energy that allows the continued use and abuse of the substance. Enabling: Unfortunately, the family member of the addict is often the very person that makes the addict ABLE to continue using. Usually, the family member simply wants to help. The addict may say he/she wants to stop using or get help to stop using. As the family member “helps”, he or she often unknowingly ends up securing a way for the addict to continue using instead of actually helping the addict to get better or stop using. An example would be a mother who agrees to help pay an electric bill because the addict is having financial problems. Once the addict has the money that is meant to pay for the bill, he or she immediately uses the funds to attain more of the addictive substance. Once I had spoken about these topics, I decided to respond to the increasing awareness that I had of how much emotional pain many of the family members in the room were in. I decide to speak about attachment. I noticed that most of the family members were parents of an addict and only a few people were partners of an addict or some other significant person. Attachment: This term is used in the world of psychology to describe the natural bond between a parent and a child that is necessary for survival as well as development of a healthy and confident psyche. Attachment is our first experience of love. When the parent nurtures and holds the child, the child feels loved and safe. This experience of love and compassion becomes the building block for future understanding of what love and compassion is. The very nature of humanity is such that we instinctually attach to the care giver that allows our survival. A parent of an active addict will inevitably suffer tremendously and find it extremely difficult to stop being, thinking and doing attachment oriented behaviors that feel natural in the role as a parent. I added this topic about attachment in my presentation because I realized that in front of me sat a group of people that had already heard all about enabling and setting boundaries with the addict. What had perhaps not been talked about as much was the topic of Love

and Compassion. It was clear that these parents love their alcohol and drug addicted children very much and the group members expressed open feelings of sadness and lack of hope due to a sense of powerlessness about stopping the destructive process of addiction. As I moved on to the question and answer section of my talk, I found myself answering in ways that would provide some hope despite the fact that the answers I gave did not always provide positive information. The world of addiction treatment supplies many options for addicts who want to recover, but those that do not want help must suffer consequences that can be dangerous and even lethal. This fact, that the addict must suffer in order to get better, is a very important aspect and a harsh reality that parents of addicts face every day. There was a couple in the group that admitted freely, (because of many years of dealing with their son’s severe heroin addiction) in front of everyone in the group, that they had experienced feelings of anger and hurt for so long that they had begun to feel indifference about what would happen to their addicted son in the end. The group discussion focused for a moment on guilt and lack of hope. Many of the family members spoke about having felt very negative feelings about the addict and sometimes wishing for ability to completely give up on the addict. This discussion was in my opinion very important and perhaps the reason I agreed to write this article. I had a conversation after the presentation with the facilitators of this group; Dr Kermit Halperin and his wife Natalie. I recognized then that the real reason the family members of addicts really benefit from attending a support group like this, is that it regularly reminds the family member that they are NOT alone and that there ARE addicts that get sober and survive. Addicts do die from their addiction. Every time a parent is told “not to help too much” or “to detach and not enable the addict”, the family member faces their very own deep fear of the addiction destroying their child. The support group FA (Families Anonymous) is a place where family members can combat the feelings of powerlessness and gain HOPE about recovery. The family member can begin to trust that their love and compassion for their substance abusing child can be transformed into healthy actions that will push the addict toward sobriety. The family member learns that in order to truly help another one must first help oneself. The lesson is that the parent has NOT abandoned their child when they detach from the addict. They also learn that there IS a recovering community. There is help for both the addict and the family member. The parent of the addict can feel desperate and question if it is possible for their son or daughter to recover. By attending FA meetings a family member can discover that only by helping themselves - by seeking support and learning that it is ok to ask for help – not doing everything by yourself - they truly CAN help the addict get sober. This Group meets on Tuesdays at Patch Reef Park, Boca Raton. If you have questions, please contact Dr Kermit J. Halperin at 561-483-7587 or go to www.familiesanonymous.org. to find out more. There is also another FA group in Wellington. The contact person for that group is: Richard Gioia: (954) 695-2130. Hanna McGoey LMHC (Licensed Mental Health Counselor), CAP (Certified Addiction Professional), has a private office and counseling agency in Boca Raton. She has 27 years of experience counseling people with mental health and substance abuse problems. She has extensive experience as a therapist but also as a supervisor and a trainer of therapists. Her primary interests focus on Ethics Training of Counseling Professionals and making Mental Health and Addiction Treatment available to addicts and their families.

A DV E RT I S I N G O P P O RT U N I T I E S

The Sober World is a free magazine for parents and families who have loved ones struggling with addiction. We offer an E-version of the magazine monthly. If you are interested in having a copy e-mailed, please send your request to patricia@thesoberworld.com For Advertising opportunities in our magazine or on our website, please contact Patricia at 561-910-1943. We invite you to visit our website at www.thesoberworld.com You will find an abundance of helpful information from resources and services to important links, announcements, gifts, books and articles from contributors throughout the country. There is an interactive forum where we invite and encourage you to voice your opinion, share your thoughts and experiences. We strongly encourage those in recovery and seeking recovery to join the forums as well. Please note: Our forum allows you to leave comments anonymously. Please visit us on Face Book at The Sober World or Steven Sober-World Again, I would like to thank all my advertisers that have made this magazine possible, and have given us the ability to reach people around the world that are affected by drug or alcohol abuse. I canâ&#x20AC;&#x2122;t tell you all the people that have reached out to thank us for providing this wonderful resource.

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WHAT IS A LEVEL 4 TRANSITIONAL CARE HOUSE? Sunset House is currently classified as a level 4 transitional care house, according to the Department of Children and Families criteria regarding such programs. This includes providing 24 hour paid staff coverage seven days per week, requires counseling staff to never have a caseload of more than 15 participating clients. Sunset House maintains this licensure by conducting three group therapy sessions per week as well as one individual counseling session per week with qualified staff. Sunset House provides all of the above mentioned services for $300.00 per week. This also includes a bi-monthly psychiatric session with Dr. William Romanos for medication management. Sunset House continues to be a leader in affordable long term care and has been providing exemplary treatment in the Palm Beach County community for over 18 years. As a Level 4 facility Sunset House is appropriate for persons who have completed other levels of residential treatment, particularly levels 2 and 3. This includes clients who have demonstrated problems in applying recovery skills, a lack of personal responsibility, or a lack of connection to the world of work, education, or family life. Although clinical services are provided, the main emphasis is on services that are low-intensity and typically emphasize a supportive environment. This would include services that would focus on recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the world of work, education, and family life. In conjunction with DCF, Sunset House also maintains The American Society of Addiction Medicine or ASAM criteria. This professional society aims to promote the appropriate role of a facility or physician in the care of patients with a substance use disorder. ASAM was created in 1988 and is an approved and accepted model by The American Medical Association and looks to monitor placement criteria so that patients are not placed in a level of care that does not meet the needs of their specific diagnosis, in essence protecting the patients with the sole ethical aim to do no harm.

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OVERCOMING ROADBLOCKS TO RECOVERY THE EMERGING BRAIN SCIENCE OF ADDICTION, TRAUMA AND SHAME By Thomas Hedlund

Our science is beginning to catch up with our intuition. In the past few years, due to advances in brain science technology, we are beginning to gain fundamental understanding into the actual working of the human brain. This is leading us to new insights into the sometimes-baffling nature of addiction, post-traumatic stress, and relapse. As we have new capability to investigate and observe human brains actually in the processes mentioned, we are beginning to understand the difference between normal human brain functions, and those of both addiction and trauma bound individuals. We can now actually see the differences in functions and brain organization that occur as a result of addictive behaviors and how trauma invades brain development and creates new pathways and obstacles for survivors to cope with. In short, the brain’s solutions and adaptations to problems, become problems in themselves for the person to overcome on their pathway to recovery. Let me start with the story of Clyde. Clyde was a United States Marine Veteran, who had almost been killed by friendly fire on three separate occasions during his stay in Vietnam. Once buried alive and left for dead by his buddies, another time the sole survivor of an artillery round falling short, killing his whole platoon, and another horrific event, where in all cases, not only the “enemy” was trying to kill him, but his friends almost did too! A back ward vet prior to my meeting him, he was maintained on seven different medications, married to a lovely co-dependent woman, Clyde was having trouble sleeping. When I asked him how he relaxed, (he was trembling, rocking and shaking in my office)…he said that if the voices and noises in the night got too intense, he would reach under his bed, take out his M-16, put a round in the chamber, and place his finger on the trigger, release the safety, put the muzzle in his mouth, and then he could relax! All this while his wife slept soundly next to him, and his children slept nearby in another room. His reasoning was simple, he now had control over the events, he was now master of his own destiny and he could stop the intolerable fear and pain. These images troubled me for years. He was calming and soothing himself with his ability to kill himself! This made no sense to me at the time, but I had much more to learn about addiction and trauma in the years to come. Today, I see this as the hallmark of addictive behavior that our self-soothing behavior has gone completely awry. Our many and various forms of compulsive, self-abusive and self -destructive behavior are often attempts to regain lost control over our emotions and our nervous system and provide a sense of mastery and relief. Today we know that trauma sits in the limbic system of the brain in such a way that we continue to live in the emotional climate of that trauma long after it is over. This part of the brain has no clock, no sense of time. When it is activated, through circumstances, events, thoughts, sensations, feelings or memories, the experience is one that takes place in the present, not the past. Complicating things further, we now know that the more we are aroused by fear, the further down the brain system we regress in our thinking ability. As we become more afraid, our thinking brain starts to shut down! “We do not know the things we know!” Furthermore, we have learned that adrenaline consolidates memories, so that when we experience this arousal, current events then also become triggering events, so that we are progressively incorporating more and more stimuli as triggering mechanisms, thus losing more and more conscious control over our emotional states. New animal research has indicated to us, that this very existence of stress within the brain can actually trigger the reward seeking response. What this means is that as we lose containment of our emotional states, and brain stress accelerates, the natural mechanism to compensate for this is the very system that addiction has corrupted! Since in both cases, these structures primarily involve the midbrain and

limbic system of the brain, the activity taking place is not only beyond our conscious control, it actually takes hold of our conscious activities and directs us towards the compulsive “cure”. Just as the trauma and adrenaline consolidate memories in the brain, so do addictive chemicals and behaviors. Consequently, more and more stimuli and circumstances become occasions to “use” as addictive disease progresses. So, the very parts of the brain that would otherwise counsel us to think more carefully about what we are about to do, have also been recruited by the deeper systems of the brain to HELP US FEEL BETTER RIGHT NOW by doing the very thing that will cause further problems! Sadly, once the reward / pleasure pathways are activated, the brain tells us that everything is ok, and is remembering how we did this. This repeated activity and learning becomes the primary circuitry of the brain. The brain develops through activity, so that it becomes more and more efficient repeating these thoughts and behaviors. Both of these systems in the brain are called the action circuits. This means that they originate in the deep structures of the brain that involve action without the need for prior thinking. This helped to explain the shocking realization of my research (personal and professional) that these reward-seeking pathways are not involved in the consideration of negative consequences! Involved only in the pursuit of relief and pleasure, they operate independent of any regard to threat, negative consequence, or rational thinking. So, picture our thinking brain going offline, as stress accelerates, and our pleasure / reward pathways directing us towards behaviors that more rational people would avoid and it is easy to imagine, the sense of hopelessness and shame that is created from these reactive, irrational, self-defeating behaviors. These feelings of hopelessness and shame, then by themselves can and will activate the mechanisms further, leading into the downward spiral into powerlessness and unmanageability associated with all addictive behaviors. One dear friend commented, “This is great! Now that you have convinced me that my brain is broken you haven’t given me a new one to fix it with!” On a more hopeful note, the exciting thing about all this science is that it provides validation for the twelve step recovery processes. The various processes of sponsorship, self-examination, self disclosure, learning to depend and rely on others for help, and to follow defined structure and spiritual principles actually provide vast amounts of support for changing how our brains think and developing new pathways of action which are life and health enhancing. With education and accurate information we can begin the never ending process reducing and healing shame, trauma and addiction. We can continue to create effective programs that actually support people in reclaiming conscious control of their nervous systems and lives. And we can begin the process of helping children and parents prevent shame and trauma before it can create the voracious hole that fuels all addictive processes. And as science continues its progress, we may eventually find concrete solutions to assist us in reducing our vulnerability to both the internal and external circumstances that have caused so much human suffering. Thomas Hedlund is a marriage family therapist, workshop leader and educator from Santa Rosa, Ca. Bestselling author John Bradshaw has called Thomas Hedlund “one of the select few therapists who I know that thoroughly understands the dynamics of emotional healing.” After 35 years in private practice he works as a communications, addiction, family systems consultant and interventionist. His trainings and seminars are in demand at treatment centers across the United States, United Kingdom and Australia.

OUT OF THE WOODS By Diane Cameron

When we were “younger” in recovery we heard things like, “The person who got up earliest this morning is the one with the most sobriety”, or “All anyone has is this 24 hours.” We were cautioned not to be fooled into false security based on the number of years we had in recovery. We heard, “While you’re in meetings, your addiction is over in the corner doing push-ups”, or “The longer you are sober the closer you are to a drink”. These sayings are intended to warn us against hubris and pride. So why make a point of the ten-year mark in recovery? Why a special blog for men and women who’ve been sober ten or 15 or more years? Because while the basics remain the same some things really are different the longer we go on our recovery journey. And sometimes we wonder about ourselves and sometimes our family and friends wonder what’s up as we grow up in recovery. I wrote the book, “Out of the Woods” to address these questions and these changes. Recovery at ten-plus years can have glitches and questions. I want all of us to compare notes, to see that there is common ground, and to reassure us that there is no one way and no right way to be recovering. Some of us still go to three meetings a week while others go once a week or once a month. Recovering folks meet for lunch or dinner or take weekly walks together. What about service? All those things we did to get well or that we aspired to when we were “growing up” in AA? Some of us do bake cakes and chair meetings for our home group while others have taken the slogan: “Service is gratitude in action” and extended it out into the broader community. The words and settings may be different but when we teach adults to read or counsel teens after school it’s still service and gratitude in action.

www.centralrecoverypress.com/out-of-the-woods

The God question, which was there on our first day in recovery, remains. We learned early on that we had to figure out who, or what, we were turning our lives over to. That desire has led us down some pretty interesting paths. You can find 12-step people in Quaker Meetings, yoga classes, meditation workshops, and in every kind of church or synagogue. We’re probably disproportionately represented in alternative forms of worship and we’ve taken many a road less traveled on our way out of the woods. Many of us change jobs, and sometimes careers, in our later recovery years. Going back to school is common. It’s a consequence of learning more about ourselves. We choose new careers based on who we really are rather than what would please or impress someone else. When we look closely at our lives we seem to be okay. It’s true we don’t go to meetings every day and we might not make the coffee at our home group anymore but life is good. But we want to be sure that we’re not kidding ourselves that doing our recovery differently is a move toward growth and not toward denial or relapse. Most of us in “double-digit” recovery discover that the 12 steps and a program of recovery are part of a good life. And we can continue this good, recovering life a very long time. We are ever vigilant. Relapse is still an option but we have well-practiced habits, a community and a set of tools. Diane Cameron is the author of the new book, “Out of the Woods” published by Central Recovery Press. “Out of the Woods” describes the journey of long-term recovery for women. It is also a resource for family and friends of people in recovery. Diane is available for talks and conference presentations. Contact Diane at www.DianeCameron.info or www.WomeninRecovery.blogspot.com

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“WE’RE AT WAR”: BATTLING THE “LEGAL HIGH” DESIGNER DRUGS AND EMERGING NATURAL SUBSTANCES By Pat Pizzo Director of Toxicology, Alere Toxicology Services

What will 2014 bring? With more than 450 compounds to choose from and the ability to develop new products, the list of possible compounds is nearly endless. Effects on Users How does the use of the synthetic marijuana compounds affect the user? Acute effects such as euphoria, sedation, nociception (the neural processes of encoding and processing noxious stimuli), perceptual distortions and appetite stimulation have been observed and documented. The duration of effects of the synthetic marijuana compounds is dependent on the specific compound chosen. Examples are listed in Table 2. Table 2 Compound THC- Marijuana JWH-018 CP47,497 HU-210

Duration of Effect 2-4 hours 1-2 hours 5-6 hours ~24 hours

Dr. Robert Kronstrand, SPFT WS9, Oct 2013 (1)

Synthetic marijuana compounds have been known to cause undesirable effects. Numerous researchers across the world have conducted studies or case reports of usage and found a variety of undesirable effects ranging from red eyes, dry mouth, appetite stimulation, thought disruption and sedation to sever effects such as hallucinations, delusions, aggression, arrhythmia, tachycardia, elevated blood pressure, nausea, vomiting, depressed locomotion and hypothermia (URL 44), kidney failure (XLR 11), seizures and loss of consciousness. Research on the excretion patterns of the synthetic cannabinoids is limited because it is classified as “Not for Human Consumption.” De Jager published a study on one subject with a single intake of a synthetic marijuana compound and found the maximum excretion in the urine occurred approximately 2-3 hours after smoking and the maximum level detected was 10ng/mg.(2) Research in mice done by Poklis indicated the brain contained higher concentrations of JWH018 and JWH073 than the blood. (3) Law, Legislators and Labs Synthetic cannabinoids are here to stay. Law enforcement, legislators and laboratories will always be behind in providing information on these compounds. The producers of the illicit products can produce and publish information on the Internet at an alarming rate. Law enforcement must become aware of the new products and do a better job of lobbying legislators to pass laws. Even with the pressure the U.S. government received, it took three years to pass legislation making only 18 synthetic marijuana compounds and 5 synthetic marijuana drug classes Schedule 1 controlled substances. Laboratories cannot test for all compounds. Before testing can be offered to clients a lab must acquire standards from a reliable source, develop methods and validate those methods. This process can require many months. If you wish to test for the synthetic cannabinoids be sure to check with your laboratory to learn what substances that lab can actually detect. Many labs offer immunoassay screening tests that will only detect 1st and possibly 2nd generation synthetic cannabinoids. Screening and confirmation with LC/MS/MS would offer detection of the largest number of compounds. Always check with your drug test provider to ensure you are knowledgeable on what compounds are actually being tested in both your screen and confirmation. Designer Drugs In addition to cannabimimetics, other chemicals being labeled as “Designer Drugs,” including cathinone, piperazine, phenethylamines, and tryptamines, have become a major concern in the United States. In early 2000, a huge amount of designer drugs were sold over the Internet. To get around existing drug laws, chemists make designer drugs by modifying the molecular structure of a compound in an existing illicit drug or by finding new substances that mimic the affects of a

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currently illegal drug. They are manufactured and marketed as plant food or bath salts, and promotional material and packaging stipulate that they are not intended for human consumption. Yet, even at that people inhale or ingest them to gain stimulant effects similar to cocaine or methamphetamine. Just like cannabimimetics, these products can be purchased online or at convenience stores, truck stops, and head shops. The most common chemical found in designer drugs is cathinone, and it can be used to make 43 other compounds by substituting elements in its structure. Cathinone is a plant native to West Africa, is usually chewed, and sells for $50 to $150 per plant. Designer drugs of this type have been recognized and banned in Australia and Europe for some time. Mephedrone is one compound derived from cathinone and it is sold on the Internet as plant food. The effects of Mephedrone are similar to amphetamine and its use has been responsible for several deaths in the United Kingdom. The most common derivative of cathinone, MDPV, is found in “bath salts.” MDPV mimics the effects of cocaine. Readily available in stores and online for $4 to $20 per package depending on the size, bath salts are snorted, smoked, or taken orally. The product package clearly indicates “Not for Human Consumption,” and the websites that sell these products have listed disclaimers such as:

“TERMS AND CONDITIONS: By entering the website of and ordering from PremiumBlendHerbal.com you agree to our Terms of Service and use as expressed below. You also affirm and agree to the following: That you are 18 years of age or older. NO EXCEPTIONS! Buyer agrees that any herbs, herbal blends, and or any other products on this site are legal to sell and/or purchase in your physical location or point of receipt of shipment. You agree to use our products for their intended purposes only. You waive without exception your right to hold Seller liable in any way for the misuse of Seller’s products.” MDPV use can cause hallucinations, increased heart rate, seizures, paranoia, kidney failure, violent behavior, and death. Several fatalities in the United States have been directly linked to the use of MDPV, and the major abuse seems to be in the South and Midwest portions of the country. The Poison Control Center in Louisiana reported 234 calls concerning bath salts for the year 2010. In January of 2011, the same Poison Control Center reported 248 calls from 25 states concerning bath salts. More than 40 states have passed legislation to ban the use of bath salts. July 2012, President Obama signed the Synthetic Drug Abuse Prevention Act, instituting a Schedule 1 federal ban on two designer stimulant drugs and nine synthetic hallucinogens. MDPV and Mephedrone are the two designer stimulants. Other Compounds Other compounds not derived from cathinone are also considered designer drugs. Phenethylamines and Tryptamines are known as psychedelic amphetamines and have been around since the 1980’s. The DEA classified these as Schedule I; however, it has not stopped their use. Between 2004 and 2009, the DEA had 20 successful seizures across 13 states. Some of the main products in this classification are DOM, DOB, DOI, 2C-1,2C-B, and 2C-E. Europa, the common name of 2C-E, has recently been responsible for several deaths in the United States, and another product known as BromoDragonfly has gained popularity on the West Coast. Another class of designer drugs that has been classified as Schedule I is Piperazine. The most frequently encountered derivatives of Piperazine are BZP, TFMPP, MDBP, and MeOPP. Several of the drugs in the cathinone and piperazine family can be tested. At least one laboratory is testing for the following compounds: MDPV, Mephedrone, Bytylone, BZP, Cathinone, Ethylone, MBDB, mCPP, MDMA. MDEA, MDA, Methcathinone, TFMPP, and Methylone. The analysis is a screen by GC/MS, and a confirmation by GC/MS on a separate specimen. Continued on page 28

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“WE’RE AT WAR”: BATTLING THE “LEGAL HIGH” DESIGNER DRUGS AND EMERGING NATURAL SUBSTANCES By Pat Pizzo Director of Toxicology, Alere Toxicology Services

Continued from page 26

Plant Material

Conclusion

A large number of plants will produce effects desired by individuals who wish to abuse drugs. Easily located and purchased through the Internet, Salvia Divinorum, also known as Diviner’s Sage, Ska María Pastora, or Seer’s Sage, is a psychoactive plant which can induce dissociative effects. It is a potent producer of “visions” and other hallucinatory experiences. The initial effect of Salvia Divinorum is believed to last for 2-5 minutes, but the after-effects can continue for hours. Several deaths have been attributed to the use of Salvia, and this plant has been banned in 17 states with 13 other states considering bans. It is legal for non-human consumption in four states, and legal for adults but illegal for minors in three states. One state has written legislation banning the manufacture, sale, or delivery of Salvinorin A, but possession of it remains legal.

As indicated, many of these cannabimimetics, designer drugs, and plant materials used by recreational users to circumvent current drug laws have been made illegal themselves. In addition, laboratories are developing methods to detect these compounds for workplace or criminal justice drug testing programs. Just as quickly as these products come into the recreational drug scene, governments and testing laboratories will have to address them.

Other plants as common as Kratom, Morning Glory seeds, Angel’s Trumpet, and Wormwood can produce the same effects as illicit drugs. Kratom, a plant native to Thailand and Malaysia, has been reported to have effects similar to both opiates and cocaine depending on the amount used. Morning Glory seeds when properly prepared have the active ingredient Lysergic Acid Amide (LSA) which acts as a psychedelic or hallucinogen. Angel’s Trumpet contains belladonna alkaloids, such as atropine and scopolamine, and acts as a hallucinogen. Wormwood is used to make Absinthe, and its active ingredient is Thujone. Thujone can cause effects such as disorientation, euphoria, and dreamlike states. The plant kingdom is very large, and we have just touched on some of the naturally occurring drug effects found in plants.

Perhaps the biggest deterrent to the use of these substances is the danger involved in using them. User may think they are a safe and, in some instances legal replacement for illicit drugs without a clue regarding the potential deadly consequences. While the effects of the substances may be the same without the risk of punishment, anyone using a substance not intended for human consumption runs the risk of doing long-term damage to their health or ultimately ending their life. Before being the Director of Toxicology at Alere, Pat Pizzo worked as a chemist in the Toxicology Lab for the Federal Bureau of Investigation in Washington, DC. She is a former member of the Federal Drug Testing Advisory Board, an Inspector for the National Laboratory Certification Program and the College of American Pathologist Forensic Urine Drug Testing Program, and Board Certified Forensic Examiner. She has been certified as an expert witness in Federal and State courts and has testified throughout the country.

EVIDENCE BASED TREATMENTS FOR ADOLESCENT SUBSTANCE USE AND DSM-5 MENTAL DISORDERS By Dr. Barry M. Gregory Ed.D., M.Ed., LMHC

daughter who is still injecting heroin to live at home to avoid the loss of him, or having him move out of the house. Phase 2 interventions focus on core behavior change strategies which include improving communication and problem solving skills in everyday family interactions. Early efforts are made to increase positive family interactions and activities that help reward new sober behaviors. Other change strategies include teaching clients and families about assertiveness training, anger management, negative mood management, refusal skills, coping with cravings, and contingency management. Phase 3 involves helping clients with school and legal problems and teaching relapse prevention. Family involvement in treatment also provides the opportunity for parents to learn new parenting practices. Despite the challenges with raising children and adolescents especially with behavioral and addiction problems, most parents report they never attended a parenting workshop. Healthy families and positive parenting practices can provide a highly effective after care environment for teens who complete and are discharged from treatment. Parental praise and attention are by far the most effective ways for teachers, parents and counselors to change and improve teen behaviors. Teens especially need parents to listen more and to offer more choices. Kids respond better to parents who say please and give clear directions in a calm tone of voice. Harsh coercive parenting practices that rely on threats and punishment are not effective in changing behaviors. Paying attention to oppositional and defiant behavior only increases or maintains these unwanted behaviors. Ignoring behaviors reduces negative behaviors like temper tantrums. While it’s understandable why parents enable, fix, and protect teens and young adults with addiction problems, this approach does not reduce alcohol and other drug use. Enabling rewards and maintains addictive behaviors. Parents can help teens to engage in more healthy positive activities including more fun

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family activities that reward clean and sober attitudes and behaviors. Parents can also improve teen attitudes and behaviors by developing home contracts that describe desired behaviors and the consequences used to promote and reduce these behaviors. Home contracts clarify home rules and expectations. Consequences include praise, attention, points, rewards and privileges for compliance with the home contract. Time out, loss of valued privileges, and mild punishment when mixed with rewards has been found to be effective. Mild punishment can include a stern look, verbal reprimand, or a logical loss of a privilege. Taking a cell phone away or grounding a teen for a day is more effective than grounding them for 2 weeks. Parents who listen more and give calm clear directions about expectations get more cooperation. While raising and treating children and teens can be a very challenging job today, parents and treatment centers have more proven and practical tools to help children and adolescent who so desperately need our unconditional love and support. Article References are Available upon Request Dr. Barry M. Gregory Ed.D., M.Ed., LMHC is CEO of the National Addictions Training and Consulting Institute and maintains a professional training, consulting and private practice in West Palm Beach Florida. He has over 20 years of experience in the mental health and addiction fields specializing in the implementation of evidence based practices. He has conducted over 600 national evidence-based training seminars for addiction and mental health professionals. His company specializes in providing addiction treatment centers with high quality consultation services that help providers understand and comply with common licensing standards and best practices. Dr. Gregory is also the author of the recent best book: The CBT Skills Workbook: Practical Worksheets and Exercise to Promote Change. Watch for dates for the next Free Parenting Workshops at his website: www.drbarrymgregory.com

LET’S EXPLORE THE LEARNED COMPONENT OF MOTIVATION

By Dr. Silvernail, PhD Let’s explore the learned component of motivation in relation to substance use, abuse, and addiction to understand the concept better. The development of substance dependence can be seen as part of a learning process. For instance, if you heard from somewhere that a drink at the end of a hard day’s work lessens your stress and helps you unwind and if commercials also advertise this notion and support this thinking, then environmental factors support your decision to use alcohol and drugs to cope with stress. Motivation and incentive are important concepts with regard to substance dependence. A person abusing a substance experiences a psychoactive effect. This effect is highly rewarding or reinforcing and activates the circuits in the brain that makes it more likely that this behavior will be repeated. The brain has systems that have evolved to guide and direct behavior toward stimuli that are critical to survival. Therefore, each time the person feels stressed, he or she associates it with a drink or a pill (associated learning; conditioned stimuli). Let’s look at an example. Stimuli associated with drinking and coping with stress activate specific pathways and reinforce the behaviors that lead to obtaining corresponding goals. Psychoactive substances artificially activate the same pathways, which are activated by important stimuli, such as food, water, danger, and mates. The brain is tricked by the substances into responding as if the substances and their associated stimuli are biologically needed, therefore, leading to enhanced motivation to continue this behavior. Thus, according to this theory, dependence is the result of a complex interaction of the physiological effects of substances on brain areas associated with motivation and emotion, combined with learning about the relationship between substances and substance-related cues. Dr. Silvernail is a Licensed Mental Health Counselor with a PhD in Psychology and Addictionology Counseling. Dr. Silvernail is the CEO of Silvernail Consultant Services, (www.SilvernailConsultantServices.com) and currently is the Clinical Supervisor for Total Recovery Now in Lake Worth.

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THE SILENT ASSAULT ON AMERICANS WITH ADDICTIONS

OVER 100,000 PEOPLE HAVE PERISHED ALREADY – SOME OF THEM IN MY ARMS By John Giordano DHL, MAC

to market a car with faulty safety features?! Elected officials in both the House and the Senate have announced plans for at least two Congressional hearings to investigate the failed air bags, yet they’re completely silent on the over 100,000 deaths – some of them in my arms – in the last decade at the hands of prescription painkillers. Not a word; not so much as a peep. Where is the disconnect? There are some that will tell you that drug overdoses are the result of poor choices; that the addict got what they deserved and they need to be accountable for their own actions. As for the accountability, I agree. People must accept responsibility for their actions. However the rest of the aforementioned statement is simply unsubstantiated and is an outdated opinion preached by the grossly under-informed. Years ago my close friend and colleague Dr. Kenneth Blum – discoverer of the addiction gene – did a study at my addiction treatment center. The results revealed that three out of four people being treated for addiction had a genetic predisposition to the disease. Dr Blum claims this result is consistent with similar studies he’s done elsewhere. For people with a genetic predisposition to addiction, their choices are foggy at best. Their brains are wired differently. For them, the intense cravings are like a severe sun burn to someone else, they’ll do just about anything to ease the pain, or in this case, cravings. Most people are under the misconception that addiction is strictly drug abuse. Nothing could be further from the truth. Addiction is a brain disease with many expressions. Take food for example. Have you ever wondered what pushed the U.S. over the edge in becoming the world’s most obese country? Certain foods can be just as addicting – although less intense – as opioids? It’s true. Sugar, and anything the turns into sugar in the body, had a similar effect on the brain as cocaine. What is even more concerning is that for decades the major process food companies have been using people’s addictions to help sell more products. In his bestselling book: Salt Sugar Fat: How the Food Giants Hooked Us by New York Times Bestselling Pulitzer Prize–winning investigative journalist Michael Moss takes you behind the scenes of the process food industry. In his book the author goes into great detail on how for decades major process food companies have been spiking the national food supply with addictive agents that trick the brain into thinking it’s still hungry, thus forcing more sales. He claims more meals are being designed in laboratories than in kitchens. His book is worth a read. If nothing else, check out the introduction online. Is there a silent assault on Americans with addictions? Are people with addictions being exploited for profit? The poignant facts speak for themselves. 100,000 Americans died from a prescription drug overdose in the last decade, prescription drug overdoses are the leading cause of accidental and preventative deaths in the U.S., the CDC declared prescription drug addiction as an epidemic long ago, 425,000 emergency department visits for misuse or abuse of opioids, including overdoses in 2013 – up from 166,338 in 2004, one in three adults, one in five kids in the U.S. is clinically obese and diabetes in the United States has doubled in the last ten years and so on. I could go on but the picture is crystal clear; whether you choose to see it remains the question. A close friend of mine has a saying: “when elephants fight only the ants get killed.” How many more Albert’s have to die before the people we’ve elected to protect us stop pretending we’re invisible? The FDA was created to protect us from specifically these types of deadly products; yet they continue approving poison (many of which are banned in most modern countries) for public consumption based on a company’s promising pro forma. Is the economy really worth it; is it worth killing hundreds of thousands of innocent Americans? Have we become a cannibalistic economy where we feed on our own? Can’t these companies find a better use of their time and resources or are their year end bonuses just too much to say no to? As I mentioned before I’m big on responsibility and accountability. Addicts need to be responsible for their actions and so do the CEOs

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of the pharmaceutical companies that supply the poison and the elected and appointed government officials charged with regulating these drugs and are responsible for our safety. With the “at any cost” mentality of gaining market share, improving the bottom line and beating the competition in this $20 plus billion dollar industry comes the causalities of corporate battles – the Albert’s of the world. Dr. Samual Evans Massengill, the owner of the pharmaceutical company that poisoned people in 1937, said this about the incident: “My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product.” We’ve all heard similar refrains from other CEOs in similar situations over the years. Consumer safety is an after thought, if it is even that. It’s time for our appointed government officials to put an end to this madness by simply doing what we elected them to do – their job! John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies, Laser Therapy Spa in Hallandale Beach and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: http://www.holisticaddictioninfo.com

THE MANY FACES OF EARLY SOBRIETY By Marcia Ullett, MA

Continued from page 18

7. Keep busy and socialize. The last thing any of us need is to sit around and think. Most of us come to sobriety without many friends and having become isolative. It’s painful to be willing to say “yes” to coffee and other forms of fellowship with groups of strangers, but it can make a huge difference in our recovery. 8. Drink plenty of water. Water is a great purifier. Drinking and drugging isn’t good for anyone’s health. Plenty of water will replenish dehydration and clean us out. 9. Clean up your living space. You might be one who came to recovery with a house, apartment or car that is a mess and reflects how things were when you were drinking. Just cleaning up can make you feel like a new person. 10. Eat healthy and exercise. Even a walk around the neighborhood or out in nature can make a person feel refreshed and energized. Another of my sober friends states that at first she was afraid to drink and afraid not to drink. She goes on to say, “I looked at sobriety as LIFE 101. I became the total student so that I could learn all that there was to learn. I’m still the total student, an attitude that continues to help me live a powerful life and be of service to others.” Marcia is on a passionate journey to help people find their purpose and create a powerful vision that inspires them for years to come. As a licensed psychotherapist, she has helped thousands of people in her private practice and her work at various treatment centers, both as a clinician and a clinical supervisor. In 2006, she studied to become a certified professional coach through the College of Executive Coaching. Marcia’s 25 years of clinical experience have been of great service to her clients whom she approaches as a partner, helping them focus on their strengths and deepest values. Her amazing life story is an example of how to move out of darkness and chaos into a life filled with purpose, light and gratitude. A popular speaker and workshop leader, Marcia shares her personal story and wisdom in articles published across the Internet as well as in this book.

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